Insights: How Temperament Factors Into Dementias and Alzheimer’s Disease

In this post, we’re going to discuss how temperament factors into these neurological diseases and how we as caregivers can respond effectively and lovingly to provide balance and still meet the basic needs that our loved ones’ temperaments require.

For the purpose of this discussion, we will look at the big picture of temperaments and the two most dominant categories that each of us falls into: extraversion and introversion.

There are 16 distinct variations of these two temperaments (eight in extraversion and eight in introversion). (You can take free temperament test online to see which variation your temperament is.)

All of us fall into one of those 16 variations (for example, I have always and continue to test out as an INTJ). How we fall into them is what makes each of us unique (for example, I range between 92% and 100% for introversion every time I take the test and I suspect that variation depends on the amount of recharging solitude I have immediately had when I take the tests).

Temperaments are, in my view, a function of genetics. In other words, it’s hardwired in us before birth by DNA (nature).

Unlike other things about humans that are more fluid and can change over time, there is little to no effect from external influences that alters our temperaments.

Extroverts in a family that is more introverted don’t become more introverted, no matter how much pressure, spoken or unspoken, is applied to make them less social and more quiet.

By the same token, introverts born into a family (and into the Western world that places a very high value on extraversion) that is more extroverted don’t become more extroverted.

If anything, extroverts and introverts become even more extroverted or introverted because of the pressure applied because it conflicts with who they are at a very core level.

But equally important is whether we as caregivers are introverts or extroverts and how we may need to step outside our natural dominant temperament characteristic to ensure the needs of our loved ones are met.

Extroverts with dementias and Alzheimer’s Disease will continue to crave being social and being with and around people on a regular basis. However, because as neurological changes progress, it is not uncommon to see increased conflicts in social situations (arguing, verbal fighting, anger, etc.) or exaggerated – and sometimes inappropriate – efforts to be the center of attention.

Introverts with dementias and Alzheimer’s Disease will become even more introverted as neurological damage progresses. They will tend to isolate themselves as completely as possible, become completely withdrawn, even from loved ones, and often become completely uncommunicative before they actually lose the ability to speak and communicate.

Neither of these scenarios is good for our loved ones, so it is incumbent upon us as caregivers to try to achieve and maintain as much of a healthy balance for them to meet their needs as is feasible and possible.

In my opinion, this is one of the hardest areas to negotiate effectively and well, and it also requires the most finesse and empathy.

This is especially true if our loved ones and we have different temperaments.

My mom and I were good examples of almost diametrically opposite temperaments. Mama was an ENFP and I am an INTJ. We both had intuition (N) in common, but we were total opposites in every other way, temperamentally.

From day one of our lives together, these differences in our temperaments were a constant source of clashes and contention between us, especially in the early years. Mama would push me continually to be more extroverted and I would push back equally or more tenaciously against it.

Mama would cajole, threaten (and usually follow through because punishment was a better option for me than doing something I could not abide the thought of doing), plead, try to reason, and try to entice me to be more extroverted in a social and a public sense. It never made sense to her that it was agony for me and it literally drained me of all energy and patience.

Ironically, neither my mom and dad (who was also more extroverted than I was, but was an INFJ, so he understood me somewhat better) stopped me at home when I would go off by myself to be by myself, just to get away from everyone else when I was younger and to read, draw, or write when I was older.

But they were both concerned about my lack of desire and enthusiasm to engage in group social activities and to spend a lot of time with other people doing “fun” things. I’m sure there were many bedtime discussions between my parents about me and whether this was normal or was cause for concern.

But eventually, we all sort of adapted (Mama never completely quit trying to push me toward a more extroverted temperament, but when I would finally have a meltdown of yelling and tears in frustration – and sometimes from too little solitude too often – Daddy would intervene and persuade Mama to give me some breathing room and let me regroup, which always worked) and we figured out how to live with and love each other in spite of our differences.

As Mama’s cognitive impairment worsened over the last eight years of her life, she continued to be social and seek social activities and environments. However, as the neurological damage deepened with her, the level and number of conflicts with other people increased.

In the year and a half before Mama was diagnosed with mid-to-late stage vascular dementia and Alzheimer’s Disease, Mama’s relationships with everybody – including me – were much more contentious and much less harmonious.

On a daily basis, Mama would tell me about some dust-up with somebody. Mama had always been a bit on the scrappy side – not in a negative way, but she wasn’t afraid to take people on if they were wrong or she was protecting herself or her loved ones – but she also, because of her intuition, was able to see even the orniest of people objectively and still manage to interact in a positive way, for the most part, with them.

However, as Mama’s paranoia increased, her objectivity decreased and she began to see just about everyone in a more sinister light and as potential enemies. As a result, her social interactions, which she craved, became increasingly tense and hostile.

Just before Mama’s diagnoses and the medications that would balance out the most extreme aspects of the behaviors associated with dementias, Mama exhibited the behavior of an introvert like me.

With a profound hearing loss, Mama depended on hearing aids to connect with the world. Mama would always put her hearing aids on very soon after waking up in the morning so she didn’t miss anything.

In the few months before the inevitable crash that landed her in a geriatric psychiatric hospital, Mama often wouldn’t put her hearing aids in until late in the morning or early in the afternoon.

Mama also started isolating herself, spending the majority of the day in her apartment alone except for the time I spent with her each day.

As I went through her desk and computer when I was trying to make sense of where we were and what I needed to do when she hospitalized, I found that she’d spent a lot of time trying to write, either longhand or on the computer, and as I went through everything, I could see evidence everywhere of steep neurological decline.

It alarmed me to see the rapid progression over a few short months. I can only imagine how much more it must have frightened Mama because she didn’t know what was happening and yet she was aware that everything seemed to be quickly slipping away.

The right combination of medications brought Mama back to her true temperament and it was a relief to me and, I suspect, a relief to her as well.

She was once again involved in a lot of social activities during the day and not only did Mama thoroughly enjoy them, but other people thoroughly enjoyed her (she’d always been the life of the party and a welcome addition to any social gathering).

I made sure to encourage as much social interaction as Mama was up to and I made sure that whatever she needed to be a part of those activities she had. I would often join her in some of them, in spite of my natural aversion to that, because I knew Mama liked having me there with her and I knew that my being there made Mama feel safe.

When Mama came home to live with me, I had to continue to go outside my comfort zone to make sure she had enough social activity and interaction to thrive with her temperament. And, while it was hard at times on me, I never regretted doing that for her.

As the end of Mama’s life was drawing near and she began not knowing who I was on a regular basis and was often unable to recognize people she had known for a long time, I began to cocoon us.

The reasons were because it bothered Mama when she didn’t know people and, because they were strangers, Mama would get fearful (except for me – even when she didn’t know me, she wasn’t afraid of me and she felt safe with me).

So I began keeping the number of people with whom Mama and I interacted small and consistent so that the odds were good that Mama would remember them and so that she would not be scared.

To this day, I struggle with whether I did the right thing by Mama by doing this.

Logically, I know it was the absolute right decision because I didn’t want Mama to feel unsafe or scared.

But emotionally I question whether I should have taken the chance that Mama might have a good day and be glad to see longtime friends.

I still don’t know the answer. That will be just one more of those lingering questions that I’ll probably revisit with no resolution until the day I die.

12 thoughts on “Insights: How Temperament Factors Into Dementias and Alzheimer’s Disease”

This is an excellent post. Very interesting to hear all the things your Mother did through her journey of dementia. As my brother’s caregiver for 2 years in my home, I wrote down and documented everything my brother did each day. When I placed him in a nursing home a year ago, I continued to document his actions and what happened in his daily life. My brother does not know me or my family anymore, but he latches on to the aides around him. He always wants people near him. He had a lot of anger issues about 5 months ago, but with medication adjustments he is better. Such a sad disease. Each person with dementia is so different in their actions. As you said – personality traits have a lot to do with how they function through this disease. I never wanted to put my brother in a nursing home, but my husband almost died and is ill now. My brother would wander away in a the blink of an eye (we live in the country). He wandered 27 times in 10 months and it took police, us, friends, neighbors, and business owners to keep up with him and protect him. Stress, my what stress and so frighteneing. Sorry – another book on my part. Thanks for your information in this post. Liz

Hi Liz, I like your book posts. 🙂 Thank you for sharing your experiences with your mom and brother because that’s really the hope that this blog will be a repository of our experiences as caregivers and that our stories will help other people as they go through their journeys beside their loved ones.

My brother was taken to the hospital yesterday. He had a mini-stroke, has pneumonia and a bladder infection. I just posted a short post on “Dementia is Not on The Decline” on my blog.
Caregivers need to educate themselves about this disease. Depresses me as I watch how those in the world and in the medical profession treat those with dementia. May I ask a question of you that you might be able to answer? If they cut my brother’s antipsychotic drugs in half 20 hours before he had what the nursing home nurse called a seizure, could this have caused a mini-stroke?

Liz, it is entirely possible that the medication change – especially antipsychotics, since they generally need to be adjusted gradually and incrementally up and down to increase or decrease the dosage – contributed to your brother’s mini-stroke.

However, the pneumonia and bladder infection could have been contributors as well.

Or all three.

Generally, with mini-strokes, the root cause is sustained high blood pressure that causes small vessels in the brain to burst – and leads to cellular death around the damaged vessels.

All three of these occuring simultaneously could have definitely affected your brother’s blood pressure (is it normally high and does he take BP meds) and caused the mini-stroke.

However, the good news is that mini-strokes generally have good recoveries in a one-time instance. The real concern is whether this is an isolated incidence or your brother has a history of them (CT or MRI would show – vascular damage from a prolonged period of mini-strokes are easy to see) or if this is a new problem that could lead to vascular dementia in addition to his FTD.

Why did the nursing home cut the anti-psychotic meds in half? That’s unusual. As is that pneumonia and an oncoming bladder infection together wouldn’t have presented enough symptoms to the staff to get treatment earlier than it seems he did.

They cut his antipsychotics in half because in the 5 months he has been there they have seen no violent behavior from him. He is slowly improving after 5 days on antibiotics. They have changed his medicine so much in this last year it is unreal. He does one thing they don’t like and off he goes to be evaluated at the psych hospital and they change his meds again. There is a book I have read by Dr. Power – “Dementia beyond Drugs,” who runs a large nursing home in NY and he and Dr. Thomas are trying to get these nursing homes and doctors to stop the psychotic drugs on dementia patients. I thank you for your input and for answering my question. This has been a frustrating year dealing with these 2 nursing homes and 2 psych hospitals. Thanks friend.

You’re welcome, my friend. I know how mixed up the medicine pot can get with hospitalizations because they see someone different every time who wants to try something different. That’s why I stress medical advocacy so much for our loved ones – we’re the only ones (care facilities have too many people to be able to effectively advocate for each resident) who can manage the prescription maze and the physician merry-go-round.

Does your brother have a primary care provider? If so, I would try to get a geriatric psychiatrist on your brother’s care team who manages the psych meds and is the only one who can authorize any changes for the care facility.

Doing this should eliminate psych hospitalizations completely and it should eliminate the psych med musical chairs they’ve had him on the past year (and no wonder his behavior has been erratic and all over the place). I know this has been hard on you and it’s been on him too.

I’m glad to hear the antibiotics are helping, though, and hope that your brother continues to improve. Keep me posted and let me know. Love you and sending big hugs and lots of prayers.

He was not serving during a war. As a veteran myself I have already checked that out. I got a lawyer and fought for DHS Medicaid long-term-care for my brother and paid a penalty, but I got Medicaid when a lot of people told me I could not. So, with his social security his long-term-care is paid. Thanks for all your information and tips, I appreciate any help you give. 🙂